What’s the Risk? Medication Use

March 7, 2015

Dry mouth is an underrecognized but common side effect of thousands of over-the-counter medications, prescription medications, and dietary supplements. Due to the dramatic effect low saliva flow or poor saliva quality has on the oral health of patients, particularly increasing caries risk, the American Dental Association (ADA) commissioned a letter in April 2011 to the commissioner of the Food and Drug Administration (FDA) as well as the director of Center for Drug Evaluation and Research. In this letter, the ADA respectfully requested that the FDA consider requiring medications that are commonly associated with dry mouth side effects to carry warning-label information about the oral complications associated with reduced salivary flow. The letter specifically stated, “Without the cleansing effects of saliva, chronic[medication induced] dry mouth can lead to tooth decay1.”

Without the cleansing effects of saliva, chronic [medication induced] dry mouth can lead to tooth decay.1

For this reason, it is important to share any and all over-the-counter medications, prescription medications, and dietary supplements with your dental professional. Many of the most commonly prescribed medications are associated with dry mouth, including analgesics (pain medications), antidepressants, antihypertensives, acid reflux medications, seizure disorder medications, and antianxiety medications. Other common over-the-counter medications like analgesics (pain medications),allergy medications, antihistamines, and decongestant/cold medicines can also cause dry mouth.2 Dry mouth has also been reported by patients taking oral contraceptives and vitamins/dietary supplements.3

While each and every patient responds to medications differently, data taken on all drug consumptions, including all prescription drugs, OTC preparations, and alternative drugs, clearly shows that the prevalence of dry mouth increases with the number of drugs taken every day. As much as 20%–30% of patients taking just 1 drug daily report dry mouth. This progressively increases to greater than 60% when 6 or more different drugs are taken daily. Alternatively, less than 20% of people who do not take any drugs complain of oral dryness. This indicates that even the removal of a single drug, regardless of its dry mouth potential, may help reduce the incidence of dry mouth.4

Unfortunately for many patients, their daily medications may be an unmodifiable risk factor. Especially among the elderly, patients are generally taking multiple drugs to combat life-threatening diseases. It is not recommended to stop taking any prescribed medication without consulting the prescribing physician. For those who cannot remove medications from their diet, there are alternatives, such as saliva replacements, pH neutralization products, xylitol containing dental products, and increased fluoride exposure. (Such as CTx2 Spray and CTx2 Xylitol Gum.)